Provider Demographics
NPI:1821602780
Name:BLAND, DOROTHY JEAN
Entity type:Individual
Prefix:
First Name:DOROTHY
Middle Name:JEAN
Last Name:BLAND
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:GASSAWAY
Mailing Address - State:WV
Mailing Address - Zip Code:26624-1425
Mailing Address - Country:US
Mailing Address - Phone:850-869-0508
Mailing Address - Fax:
Practice Address - Street 1:233 RIVER ST
Practice Address - Street 2:
Practice Address - City:GASSAWAY
Practice Address - State:WV
Practice Address - Zip Code:26624-1425
Practice Address - Country:US
Practice Address - Phone:850-869-0508
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2022-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant